Screws should be placed in a tightened fashion
to allow compression of the four bones
Remaining screws should be of appropriate length
without protrusion and impingement with the articular
surfaces (Figure 8 and Figure 9)
Intra-operative fluoroscopy and standard AP
and lateral radiographs are undertaken to ensure
appropriate placement and screw fixation
Range of motion testing is undertaken to ensure
excellent stability and lack of impingement of
the fusion plate
Additional bone graft can be packed within the
center portion of the four-corner region through
the plate itself without difficulty
Post-Operative Care
Irrigation and debridement of the wound and
sequential repair of the capsule and retinacular
structures are undertaken
After skin closure, a short-arm splint is placed
allowing early active finger range of motion
After the sutures have been removed at approximately
one week, a removable splint can be placed to
allow early active range of motion exercises or
a short-arm cast can be placed for three to four
weeks of protection
Radiographs should be taken on a sequential
basis to ensure appropriate fusion of the four-corner
region prior to allowing return to normal activities
